Blog

07/17/17

The Empathetic CEO

We are in a series outlining the big ideas that would serve as the foundation for Tim’s proposed healthcare reform plan. Click here to find the prior posts.

During the early days of ALN, our health insurance broker was a little too casual delivering the news of yet another ridiculously high premium increase for the coming year. The big number and his ‘it is what it is’ attitude combined to set my partner off on a tear.

You see, Tim (the other Tim, the smart partner) gets as focused as a rat on a Cheeto when he sniffs out costs that are not only too high, but unfairly so. He found a broker with a brain and in short order, we got out of the group health game and pushed all of our employees to the individual market, complete with an innovative HSA plan and more wrinkles than I ever understood. I just know it saved our employees and the company a lot of money.

This required all of us to go through individual underwriting. For most of our people, their premiums dropped substantially. That makes sense because when a payer has to insure a basket of humans without so much as checking their blood pressure, they are going to put some cushion in their number.

We knew going in that some of our folks would get denied coverage in the general market. This group would be headed to their respective state-sponsored high-risk offering, something that was a central feature to making this work.

But it was a big change and we were most concerned about how we’d manage this with these employees. We knew it would be a hassle and we knew they’d end up with the only plan available to them. We knew their premium would be sky-high, so our plan including pulling on several levers to keep them paying about the same as what they had paid before. Still, making sure this solution worked for this group, about 7% of our employees, was going to be tricky.

Then we caught a break.

I ended up being denied coverage.

Too many knee surgeries, I think six or seven at the time (doing my part to help struggling orthopods), got me kicked to the Colorado high-risk pool. Sucked for me, but it did help our communication of the new program to others who had been denied traditional coverage.

Fortunately, the Colorado plan was smart enough to know that everyone in it was there because they had some pre-existing condition, which meant they were not only going to consume healthcare, but that they probably had long and established relationships with their providers that should not be disrupted. So, rates were good enough that most providers participated, even if the administrative burden was a little higher.

We no longer have this approach because ObamaCare kicked the legs out from under it, but it represents is a workable approach to covering the those with big pre-existing conditions, our third particularly costly cohort. We’ll explore this more next time.